Diabetes – an important update for owners! Continuous Glucose Monitoring Device

By November 18, 2019 Uncategorized

Your cat has Diabetes – that is something no owner wants to hear their veterinarian say.  The prospect of trying to manage this disease is enough to make many owners want to put their heads in the sand like the proverbial ostrich.

But it doesn’t have to be that way.

There are a number of ways to manage the diabetic patient.  We find that with cats, there is a fairly high rate of success getting them to go into remission if we diagnose it early.  I have even had some patients who did so after being “diabetic” for several years. 

We have to look at ‘why’ are cats prone to diabetes in the first place?

1 – As a species they are prone to getting low grade pancreatitis or inflammation in the pancreas.  The cells that produce insulin in our bodies are located in the pancreas – if that area becomes inflamed it can stress those cells making it harder for them to produce insulin.  

2 – Cats are obligate carnivores.  Does that mean that they never eat carbohydrates in the wild – no.  Cats will often eat the stomach contents of their prey who are herbivores.  So some grains or plant matter are consumed.  Many cats love to graze on grasses (which does not make them vomit by the way, but some do only consume grass when queasy)  – this is very common in both cats and dogs.  Researchers have not been able to single out exactly why they do it, but there is one hypothesis that it may be to ‘mechanically’ help in clearing intestinal worms.  An interesting hypothesis that bears further research, but I digress…… There is a much greater quantity of carbohydrate that is used to manufacture kibble.  Carbohydrates are necessary for the extrusion process in the manufacture of dry kibble.  Carbs are also needed for chunks and gravy canned food but to a lesser degree.  Canned pate will have the lower carbohydrate content.  So excess carbohydrate can lead to more demand for insulin from the body (just like in people) – most cats can handle this need, but some do not.

3 – Medications – steroids are an amazing and powerful class of drug that have the ability to make patients who suffer from allergies feel immediate relief.  But that does not come without cost.  For this reason they are not my first choice in treating an allergy patient.  Some patients will require them though if not responding to other treatments and/or if they have an immune-mediated disease in which case steroids can be a life-saver.  But….  they stimulate the mobilization of glucose into the bloodstream.  This is the body’s normal response to ‘fight or flight’ and steroids are normally produced in mammalian bodies to handle stress in exactly that way.  Some patients may be fine on steroids, others may be fine for a period of time and then develop elevated blood glucose levels, other individuals may develop high blood glucose the first time they receive steroids.  Often the patient’s blood glucose will normalize once the steroids are withdrawn (must be weaned off), but not always.  Some may require insulin therapy to help get the glucose down.

 

IF inflammation in the pancreas has led to diabetes in a feline patient we have a fairly good chance of getting them ‘into remission’ if we can keep their carbohydrate intake down +/- administer insulin to allow those cells to ‘rest’ until they have recovered and can start producing it again on their own.

I find that there are ~ 10-20% of my newly diagnosed diabetic patients that will go into remission with a diet change alone.  Up to 50 % after starting insulin administration, but some do not go into remission.

Insulin therapy is needed for most.  The prospect of this is daunting to most but can be managed.  Your veterinarian or veterinarian’s RVT will spend time with you going over how this is done.  Measuring the blood glucose is what seems to be the biggest stumbling block for some.  And I get it …… I have had to try to do so on my own cat, by myself.  The first time was easy – he didn’t know what I was doing.  After that it became increasingly challenging, especially since he’s black so his ear veins are not easy to see so trying to hold the cat, shine a light on the vein and poke all at once is not quite as simple as it might seem.  If possible, distraction with something super yummy may help.  For many that is enough.  For those that it is not… there is HELP.

Introducing the Libre Freestyle Continuous Glucose Monitoring Device.  This device was developed for human diabetics but is being increasingly utilized in veterinary medicine for cats and dogs too.  It is comprised of a small sampling catheter about the size of an insulin needle, that is attached to the sensor itself.  The sensor/device is round, about the same size as a Toonie coin and as thick as 2 stacked on top of each other – but much, much lighter weight.  The device has adhesive on it and for animals we apply additional drops of tissue glue to help it ‘stick’.  The area where it is going to be applied first needs to be shaved (surgical blades for close shave) to remove the fur.  Then cleaned with rubbing alcohol swabs that are provided, then dried off.  The device is applied over the prepared area with only a small amount of pressure.  It will take continuous readings of the glucose level in the ‘interstitial’ area (fluid between cells) so is not an actual blood glucose reading but correlates very well with blood glucose.   It may look/seem intimidating but let me tell you – we applied our first one last week to a patient that I was unsure would be cooperative/receptive and it was SO EASY! 

Amazingly enough, most patients do seem to leave them alone, but placing a ‘kitty sweater’ over the device or using an infant t-shirt with stretchy loose arm holes so the circulation is not cut off to the front legs and ensuring the neck opening is not too tight, may protect the device.  Most vets are not recommending applying to the neck area due to too much movement leading to premature loosening of it.  As well I have read that it may not read glucose as well if placed over the shoulder blades (scruff).  Remember this device is not measuring ‘blood’ glucose but the glucose level in the ‘interstitial’ fluid or the fluid that is between the cells in the area.  The side of the rib cage may be best but this is something to work out. 

The device will start producing readings for you after ~ 12 hours (I think, read the package insert but it is not immediate).  You can either download an app for your phone or purchase a separate reader for the device.  Once you use the app though you cannot use the reader and vice versa.   It will store data for up to 8 hours (again check the package insert) then it will start to overwrite the glucose readings – so at any time that you scan you will be able to see the readings over the previous 8 hours.  

The drawback is the device will only last for a maximum of 14 days.  Some patients will get it off in less time than that (as the fur grows back out, etc).  I have also read of the occasional device that just does not work properly which can be the case with anything.

The other drawback is cost – so I advise you contact your pharmacy first and ask what it will cost so you are prepared.

This is incredibly useful in trying to fine tune the dose of insulin for a patient, ensure that we are not administering too much insulin that can lead to hypoglycemia and then rebound high glucose levels.  It can also help for owners who cannot monitor glucose via traditional ear prick methods.  

When a patient is ‘going’ into remission it is especially important to get those pre-insulin dosing readings of the glucose to ensure we do not over-medicate and that we maximize the likelihood of remission.  This device may make that possible for owners who otherwise would not be able to check glucose levels and end up medicating and hoping it is ‘right’ for their pet. 

Here is the link to the company’s website:

https://www.freestyle.abbott/ca/en/products/libre.html?gclid=EAIaIQobChMIjrTaxbry5QIVxJ6zCh0nRQgnEAAYASAAEgJ-0PD_BwE

A link to a write up about this kind of device for pet owners:

https://veterinarypartner.vin.com/default.aspx?pid=19239&id=9150771

And a link to a youtube video of it being applied to a cat (this is not us for those who might wonder 🙂 ) 

https://www.youtube.com/watch?v=W6MyKk1vfuY

 

atlanticcathosp

Author atlanticcathosp

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